Provider Demographics
NPI:1366196719
Name:MIDDLETON, CANDI (FNP-BC)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-7455
Mailing Address - Country:US
Mailing Address - Phone:301-268-4386
Mailing Address - Fax:
Practice Address - Street 1:363 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-4607
Practice Address - Country:US
Practice Address - Phone:304-822-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty